1994 Volume 33 Issue 6 Pages 1155-1159
We report a case of vaginal clear cell adenocarcinoma diagnosed cytologically before biopsy.The patient was referred to our hospital with atypical genital bleeding and a tumor in the vaginal wall.The surface of the tumor was eroded and bled easily.Vaginal smear cytology was positive.
The smear background showed tumor diathesis. The malignant cells formed several clusters, like a ball or bunch of grapes in a sheet-like arrangement.The tumor cells had abundant, clear cytoplasm.The nuclei were large and round, with fine granular chromatin and prominent, large nucleoli.Histologically the tumor cells which had abundunt clear cytoplasm, exhibited glandular fomations and partially displayed a hobnail pattem.Their cytoplasm was PAS positive.Thus, we made a diagnosis of vaginal clear cell adenocarcinoma.The patient was treated with radiotherapy and chemotherapy because the tumor was too large to resect at one time.After these treatments the tumor had diminished enough in size to be able to resect it completely. The surgical specimen revealed no surving tumor cells.The patient was discharged and has been followed up as an outpatient.
In spite of relatively characteristic cytological features, this tumor is diagnosed prior to histological examination in only 30-70% of cases.This may be due to the method of collection.A routine smear of the cervix may not reveal evidence of a vaginal neoplasm.It is concluded that careful inspection and palpation are important and that cytologic examination of the quadrants of the vagina is necessary to detect this tumor at an early stage.
